| NPI | 1467416768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 210151) |
| Additional Taxonomies | 207NP0225X Dermatology, Pediatric Dermatology (Licence: NY 210151) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: NY 210151) | |
| Enumeration Date | 2006-04-13 |
| Last Update Date | 2023-11-10 |