| NPI | 1265643423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: HI 15562) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 60 245358) |
| Enumeration Date | 2007-05-26 |
| Last Update Date | 2023-04-10 |