| NPI | 1649467192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A118659) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 245596) |
| Enumeration Date | 2007-09-28 |
| Last Update Date | 2017-03-14 |