| NPI | 1588985188 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NJ 25MA09744900) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MD D77294) |
| Enumeration Date | 2010-06-17 |
| Last Update Date | 2015-09-01 |