| NPI | 1295993996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 249200) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: VA 0101252636) |
| Enumeration Date | 2008-05-29 |
| Last Update Date | 2020-01-21 |