| NPI | 1457351975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 138498) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 138498) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: NY 138498) | |
| Enumeration Date | 2005-07-27 |
| Last Update Date | 2020-09-17 |