| NPI | 1235298357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: NY 109733) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 109733) |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2007-07-08 |