| NPI | 1619167673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 203641) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL OS10163) |
| Enumeration Date | 2007-07-26 |
| Last Update Date | 2020-10-27 |