| NPI | 1013150630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A137455) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 266603-1) |
| Enumeration Date | 2009-04-13 |
| Last Update Date | 2023-04-21 |