| NPI | 1245211127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 272600) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: MA 220134) |
| 207N00000X Dermatology (Licence: MA 220134) | |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2017-12-21 |