| NPI | 1366971830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 329840) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA A162470) |
| Enumeration Date | 2017-06-08 |
| Last Update Date | 2024-05-23 |