| NPI | 1285812131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: SC 87069) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA 128391) |
| 207N00000X Dermatology (Licence: NY 284726) | |
| Enumeration Date | 2008-02-02 |
| Last Update Date | 2023-10-17 |