| NPI | 1649433152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MA 247358) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 254990) |
| Enumeration Date | 2008-07-03 |
| Last Update Date | 2019-09-18 |