| NPI | 1588800916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: DC MD042986) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 256656) |
| Enumeration Date | 2009-01-07 |
| Last Update Date | 2023-03-06 |