| NPI | 1801004114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: NJ 25MA0837050) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA A89501) |
| 207N00000X Dermatology (Licence: NY 233992-1) | |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2013-01-31 |