| NPI | 1396749321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NJ 25MA02387300) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: NJ 25 MA02387300) |
| Enumeration Date | 2005-06-08 |
| Last Update Date | 2015-07-27 |