| NPI | 1023082534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NJ 25MA02798000) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MA02798000) |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2012-04-25 |