| NPI | 1750525341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 264252) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MI 5101018475) |
| Enumeration Date | 2009-04-27 |
| Last Update Date | 2015-11-19 |