| NPI | 1891051306 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NJ 25MA10116400) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 283165) |
| 207N00000X Dermatology (Licence: CA A142720) | |
| Enumeration Date | 2012-04-09 |
| Last Update Date | 2022-12-12 |