| NPI | 1245548700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A147593) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 270019) |
| Enumeration Date | 2010-09-17 |
| Last Update Date | 2019-07-23 |