| NPI | 1326016742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: VT 042-0010696) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 300014-01) |
| 174400000X Specialist (Licence: VT 0420010696) | |
| Enumeration Date | 2006-03-10 |
| Last Update Date | 2026-02-16 |