| NPI | 1285625228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 250872) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MA 220481) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: CA A95073) | |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2009-08-18 |