| NPI | 1275578262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NJ 25MA06884200) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NJ MA68842) |
| Enumeration Date | 2006-06-17 |
| Last Update Date | 2010-08-25 |