| NPI | 1427050160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME143732) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 199503) |
| Enumeration Date | 2005-08-12 |
| Last Update Date | 2021-01-28 |