| NPI | 1669466819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NJ 25MA07469100) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: VA 0101054665) |
| Enumeration Date | 2005-09-02 |
| Last Update Date | 2026-06-01 |