| NPI | 1740204312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: PA MD011689E) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD011689E) |
| 208000000X Pediatrics (Licence: NJ 25MA02380200) | |
| 207N00000X Dermatology (Licence: NJ 25MA02380200) | |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2012-03-29 |