| NPI | 1457850570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: PR 023888) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 330142) |
| 207N00000X Dermatology (Licence: FL ME168488) | |
| Enumeration Date | 2018-02-04 |
| Last Update Date | 2025-09-27 |