| NPI | 1881648970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NJ 25MB07374000) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NJ 25MB07374000) |
| 207NP0225X Dermatology, Pediatric Dermatology (Licence: NJ 25MB07374000) | |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2016-07-25 |