| NPI | 1730156225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 295696-1) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NM 2001219) |
| Enumeration Date | 2006-03-02 |
| Last Update Date | 2019-03-25 |