| NPI | 1083925051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: PA MT195481) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 264404) |
| Enumeration Date | 2010-06-24 |
| Last Update Date | 2013-07-25 |