| NPI | 1922101351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NJ 25MA06217400) |
| Additional Taxonomies | 207NP0225X Dermatology, Pediatric Dermatology (Licence: NJ 25MA06217400) |
| Enumeration Date | 2006-09-07 |
| Last Update Date | 2021-04-05 |