| NPI | 1730165614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: NY 167403) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: NJ 25MA05849000) |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2024-06-26 |