| NPI | 1891719860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CT 048229) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NJ 25MA07582400) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2017-03-01 |