| NPI | 1063493898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NJ 25MA08185100) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: PA MD425589) |
| Enumeration Date | 2005-11-09 |
| Last Update Date | 2023-02-12 |