| NPI | 1972591147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: PA MD419144) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: PA MD419144) |
| 207ND0900X Dermatology, Dermatopathology (Licence: DE C1-0008078) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: NJ 25MA07850300) | |
| Enumeration Date | 2005-10-11 |
| Last Update Date | 2018-08-25 |