| NPI | 1700857257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: PA OS004256L) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 166095-1) |
| Enumeration Date | 2006-01-31 |
| Last Update Date | 2021-03-12 |