| NPI | 1407968910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NJ MA20246) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ MA20246) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: NJ MA20246) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2008-04-09 |