| NPI | 1396777041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 233192) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: KS 9406443) |
| 207N00000X Dermatology (Licence: NJ 25MA08427300) | |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2019-10-03 |