| NPI | 1215566856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WI 87141) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 324856-01) |
| Enumeration Date | 2020-04-06 |
| Last Update Date | 2026-04-29 |