| NPI | 1992730733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MD D0066908) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NJ 25MA07953600) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2013-02-28 |