| NPI | 1902948045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NJ 25MA05921800) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ 25MA05921800) |
| 174400000X Specialist (Licence: VA 0101043428) | |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2013-04-16 |