| NPI | 1396784120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: PA MD062497L) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NJ 25MA07404700) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2014-07-09 |