| NPI | 1548503576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MN 63681) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY AA5343695) |
| Enumeration Date | 2013-03-27 |
| Last Update Date | 2021-03-11 |