| NPI | 1285625160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 242192) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 002025) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: NY 242192) | |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2022-04-14 |