| NPI | 1780902585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 262147) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NJ 25MA09583800) |
| Enumeration Date | 2010-05-04 |
| Last Update Date | 2022-10-13 |