| NPI | 1891135943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NJ 25MA09997700) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY aa5343695) |
| Enumeration Date | 2013-07-02 |
| Last Update Date | 2022-05-11 |