| NPI | 1336295955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 250770) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MD D66160) |
| 207ND0900X Dermatology Dermatopathology (Licence: MD D66160) | |
| 207ND0900X Dermatology Dermatopathology (Licence: NY 250770) | |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2015-10-30 |