| NPI | 1265870299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 288041) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NJ 25MA12338500) |
| Enumeration Date | 2013-06-12 |
| Last Update Date | 2026-02-04 |