| NPI | 1700869294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207NI0002X Dermatology, Clinical & Laboratory Dermatological Immunology (Licence: NY 137939-2) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: KS 0425168) |
| 207N00000X Dermatology (Licence: NY 137939) | |
| Enumeration Date | 2005-11-29 |
| Last Update Date | 2018-03-17 |