| NPI | 1538137450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CT 021431) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 142872) |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2024-06-07 |