| NPI | 1669450375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 154618) |
| Additional Taxonomies | 207NP0225X Dermatology, Pediatric Dermatology (Licence: NY 154618) |
| Enumeration Date | 2006-01-03 |
| Last Update Date | 2008-04-22 |