| NPI | 1265525687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 142922) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: NY 142922) |
| Enumeration Date | 2006-09-30 |
| Last Update Date | 2022-09-01 |