| NPI | 1538289988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 251315-1) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 251315) |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2018-06-15 |