| 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 |