| NPI | 1538181045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NJ 25MB09014000) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 236647) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2019-02-21 |