| NPI | 1063508505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CO DR.0059144) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 140746) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2019-12-10 |