| NPI | 1497379184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 328767) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: PA pending) |
| 207R00000X Internal Medicine (Licence: PA MT220256) | |
| Enumeration Date | 2020-05-29 |
| Last Update Date | 2024-09-24 |