| NPI | 1700985314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MB07627600) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 2297301) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2019-07-18 |