| NPI | 1093788416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 093163) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL ME26062) |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2010-03-11 |