| NPI | 1962651679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: PA MD457574) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA A98058) |
| 207NP0225X Dermatology, Pediatric Dermatology (Licence: PA MD457574) | |
| 207NP0225X Dermatology, Pediatric Dermatology (Licence: NJ 25MA09814900) | |
| Enumeration Date | 2008-09-17 |
| Last Update Date | 2019-08-22 |