| NPI | 1548476385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NJ 25MB072896) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL OS9599) |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2008-07-22 |