| NPI | 1124083456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CO 0058506) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 199481) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2017-12-08 |