| NPI | 1750304663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 265513) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 15943) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2023-10-04 |