| NPI | 1366491110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NJ 25MA03772900) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: NJ 25MA03772900) |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2019-06-21 |