| NPI | 1700089851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 151105-1) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NJ 25MA04594500) |
| 207N00000X Dermatology (Licence: PA MD423153) | |
| 207N00000X Dermatology (Licence: FL ME103490) | |
| Enumeration Date | 2007-06-07 |
| Last Update Date | 2010-02-08 |