| NPI | 1316923360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NC 21054) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 245561) |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2018-07-02 |