| NPI | 1093783367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 200519) |
| Additional Taxonomies | 207NP0225X Dermatology, Pediatric Dermatology (Licence: NY 200519) |
| 208000000X Pediatrics (Licence: NY 200519) | |
| 2080A0000X Pediatrics, Adolescent Medicine (Licence: NY 200519-1) | |
| Enumeration Date | 2006-03-10 |
| Last Update Date | 2007-12-21 |