| NPI | 1336345461 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NJ 25MA08646500) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 233484) |
| Enumeration Date | 2007-06-25 |
| Last Update Date | 2013-02-13 |