| NPI | 1740245539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NJ 25MA04925300) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 156735-1) |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2017-02-14 |