| NPI | 1851845846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: PA MD060388L) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NJ 65266) |
| Enumeration Date | 2016-08-08 |
| Last Update Date | 2016-08-08 |