| NPI | 1255316121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 234923) |
| Additional Taxonomies | 207ZD0900X Pathology, Dermatopathology (Licence: NY 234923) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: NY 234923) | |
| 207NP0225X Dermatology, Pediatric Dermatology (Licence: NY 234923) | |
| Enumeration Date | 2005-12-13 |
| Last Update Date | 2014-03-28 |