| NPI | 1174590988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 120299) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: VA 31181) |
| Enumeration Date | 2006-03-01 |
| Last Update Date | 2011-10-06 |