| NPI | 1205961927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 233790) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: NY 233790) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2011-07-05 |