| NPI | 1225125347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NJ 25MA12033900) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 227814) |
| 207N00000X Dermatology (Licence: TN MD38907) | |
| Enumeration Date | 2006-10-09 |
| Last Update Date | 2024-01-04 |