| NPI | 1679553754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NC 151111) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 201827) |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2012-11-20 |