| NPI | 1154886703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 306169) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL OS20220) |
| Enumeration Date | 2019-02-07 |
| Last Update Date | 2024-05-17 |