| NPI | 1679004766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 307026) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA A172871) |
| Enumeration Date | 2017-03-21 |
| Last Update Date | 2026-03-16 |