| NPI | 1538131719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL 49416) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 1876111) |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2024-10-04 |