| NPI | 1417206459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: NY 267986) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 60267986) |
| Enumeration Date | 2012-09-06 |
| Last Update Date | 2016-09-07 |