NPI | 1730538596 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207N00000X Dermatology (Licence: NY 308444-01) |
Additional Taxonomies | 207N00000X Dermatology (Licence: FL W000-063-82-386-0) |
207R00000X Internal Medicine (Licence: PA OT017295) | |
Enumeration Date | 2016-06-11 |
Last Update Date | 2023-03-12 |