| NPI | 1366480527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 174330) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NJ 25MA05020700) |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2007-07-08 |