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 |