| NPI | 1417120932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NJ 25MA08341900) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 240347) |
| Enumeration Date | 2008-04-04 |
| Last Update Date | 2023-09-18 |