| NPI | 1427316348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 314161) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NH 17511) |
| 207N00000X Dermatology (Licence: CO DR.00588444) | |
| Enumeration Date | 2012-04-28 |
| Last Update Date | 2022-07-05 |