| NPI | 1285639518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 154861-1) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: NY 154861-1) |
| 207NP0225X Dermatology, Pediatric Dermatology (Licence: NY 154861-1) | |
| Enumeration Date | 2005-06-14 |
| Last Update Date | 2013-01-10 |