| NPI | 1831490614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NJ 25MA09546000) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 264043) |
| Enumeration Date | 2010-11-09 |
| Last Update Date | 2018-01-12 |