| NPI | 1366029886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: PA MD490365) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: DE C1-0028404) |
| 207N00000X Dermatology (Licence: NJ 25MA12855000) | |
| Enumeration Date | 2021-03-29 |
| Last Update Date | 2025-09-07 |