| NPI | 1154404895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 134724) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 134724-1) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2012-06-19 |