| NPI | 1255458105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NJ 25MA05286200) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: NJ 25MA05286200) |
| Enumeration Date | 2007-03-24 |
| Last Update Date | 2011-03-21 |