| NPI | 1477654580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 174233) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CT 040148) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: NY 174233) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: CT 040148) | |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2007-07-09 |