| NPI | 1114380284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 329763) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MA 287375) |
| 207N00000X Dermatology (Licence: NJ 25MA12268700) | |
| 207N00000X Dermatology (Licence: CA A150739) | |
| Enumeration Date | 2016-04-05 |
| Last Update Date | 2024-08-15 |