| NPI | 1164513354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NJ MA58290) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 171501) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2016-08-09 |