Registry details
Type
Individual
Primary specialty
Dermatology
Enumerated
Mar 23, 2007
License(s)
243214 (NY), BA9238610 (CA), 243214 (NY), BA9238610 (CA), 243214 (NY), BA9238610 (CA), 01065989A (IN)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 607 N MAPLE DR | Beverly Hills, CA 90210-3439 | 310-499-7129 |
| LOCATION | 550 UNIVERSITY BLVD # UH3240 | Indianapolis, IN 46202-5149 | 317-274-7705 |
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