| NPI | 1447275904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 211630) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA A79859) |
| 207ND0900X Dermatology, Dermatopathology (Licence: NJ 25MA07004000) | |
| 207N00000X Dermatology (Licence: NJ 25MA07004000) | |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2024-04-09 |