| NPI | 1386622397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL OS8835) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NJ 25MB07678400) |
| 207N00000X Dermatology (Licence: PA OS011087) | |
| 207N00000X Dermatology (Licence: NY 234461) | |
| Enumeration Date | 2006-01-09 |
| Last Update Date | 2019-12-11 |