| NPI | 1902288707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NE 31653) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NJ 31653) |
| 207R00000X Internal Medicine (Licence: NE 7473) | |
| Enumeration Date | 2015-06-29 |
| Last Update Date | 2019-08-14 |