| NPI | 1659539443 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NJ 25MA08905500) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 249723) |
| 207ND0900X Dermatology, Dermatopathology (Licence: NY 249723) | |
| Enumeration Date | 2008-05-28 |
| Last Update Date | 2023-01-12 |