| NPI | 1649619982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NJ 25MB09852700) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MI 5101019693) |
| Enumeration Date | 2013-06-20 |
| Last Update Date | 2016-06-01 |