| NPI | 1972732089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NJ 25MA09946200) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2009015645) |
| Enumeration Date | 2009-07-09 |
| Last Update Date | 2016-09-20 |