| NPI | 1609089077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MA 240816) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 247913) |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2024-09-16 |