| NPI | 1962407221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: PA MD046057L) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NJ 25MA06506200) |
| Enumeration Date | 2005-06-14 |
| Last Update Date | 2018-08-29 |