| NPI | 1205006897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: ND 15286) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 170293) |
| 207N00000X Dermatology (Licence: WI 55291-20) | |
| 207N00000X Dermatology (Licence: CO DR.0058256) | |
| Enumeration Date | 2008-03-10 |
| Last Update Date | 2020-07-14 |