| NPI | 1619062940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 1836391) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NJ 25MA06074900) |
| 207N00000X Dermatology (Licence: FL ME67211) | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2008-04-02 |