| NPI | 1740712181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 318764) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: PA MD474675) |
| 207N00000X Dermatology (Licence: CT 72197) | |
| Enumeration Date | 2017-04-03 |
| Last Update Date | 2023-03-06 |