| NPI | 1689985830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OR MD166983) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NJ 25MA09197800) |
| Enumeration Date | 2010-06-22 |
| Last Update Date | 2014-09-29 |