| NPI | 1780687228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NJ 25MA02898500) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: NJ 25MA02898500) |
| Enumeration Date | 2005-05-28 |
| Last Update Date | 2008-11-02 |