| NPI | 1679735351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: PA MD448908) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI LP01437) |
| 207N00000X Dermatology (Licence: MI 4301095221) | |
| 207N00000X Dermatology (Licence: NJ 25MA09145600) | |
| Enumeration Date | 2008-06-25 |
| Last Update Date | 2015-09-20 |