| NPI | 1871775130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NJ 25MA08998800) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: CA A94152) |
| Enumeration Date | 2007-11-28 |
| Last Update Date | 2011-02-07 |