| NPI | 1508209206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX S8898) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 287864) |
| Enumeration Date | 2013-04-11 |
| Last Update Date | 2026-03-13 |