| NPI | 1386616852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 116745) |
| Additional Taxonomies | 207NI0002X Dermatology, Clinical & Laboratory Dermatological Immunology (Licence: NY 116745) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: NY 116745) | |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2007-07-08 |