| NPI | 1609194174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NJ 25MA09196300) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: PA MD451749) |
| 207ND0900X Dermatology, Dermatopathology (Licence: NJ 25MA09196300) | |
| Enumeration Date | 2010-05-09 |
| Last Update Date | 2023-04-21 |