| NPI | 1649258286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 1940541) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NJ 25MA06377000) |
| Enumeration Date | 2006-01-04 |
| Last Update Date | 2014-06-17 |