| NPI | 1669431979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207NI0002X Dermatology Clinical & Laboratory Dermatological Immunology (Licence: NY 174606) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 174606) |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2008-05-02 |