| NPI | 1639145519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 176170) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 176170-1) |
| Enumeration Date | 2006-02-28 |
| Last Update Date | 2019-10-03 |