| NPI | 1740242031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 195658) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 195658) |
| Enumeration Date | 2006-04-04 |
| Last Update Date | 2020-02-20 |