| NPI | 1902844210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NJ 25MA08527100) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 228317) |
| 207N00000X Dermatology (Licence: NJ 25MA08527100) | |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2022-11-22 |