| NPI | 1730149501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 109440) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: NJ 25MA03018200) |
| 207N00000X Dermatology (Licence: NJ 25MA03018200) | |
| 207NP0225X Dermatology, Pediatric Dermatology (Licence: NY 109440) | |
| 207NP0225X Dermatology, Pediatric Dermatology (Licence: NJ 25MA03018200) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: NY 109440) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: NJ 25MA03018200) | |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2021-05-06 |