| NPI | 1588645451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: PA MD039074E) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: PA MD 039074-E) |
| 207N00000X Dermatology (Licence: NJ MA54018) | |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2014-03-18 |