| NPI | 1740351683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NJ 25MA06217900) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NJ 25MA06217900) |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2010-06-28 |