| NPI | 1427258367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: IA MD-43859) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 250111) |
| Enumeration Date | 2007-07-19 |
| Last Update Date | 2017-01-04 |