| NPI | 1831365303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NJ 25MA08921100) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: SC 30497) |
| 208200000X Plastic Surgery (Licence: NY 260309) | |
| Enumeration Date | 2008-05-05 |
| Last Update Date | 2012-10-16 |