| NPI | 1831359421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NJ 25MA09395800) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NY 270044-1) |
| Enumeration Date | 2008-06-17 |
| Last Update Date | 2020-05-15 |