| NPI | 1558520700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NJ 25MA08728800) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 242438) |
| Enumeration Date | 2008-06-03 |
| Last Update Date | 2019-08-15 |