| NPI | 1679630370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 103672) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 103672-1) |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2016-04-12 |