| NPI | 1487851408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A104847) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 247165) |
| Enumeration Date | 2007-07-02 |
| Last Update Date | 2014-04-23 |