| NPI | 1073735593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 252150-1) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NC 2006-01943) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2011-01-26 |