| NPI | 1174986525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CT 67524) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 303823) |
| Enumeration Date | 2016-04-02 |
| Last Update Date | 2021-04-08 |