| NPI | 1770726291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL OS12510) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 241077) |
| Enumeration Date | 2009-04-14 |
| Last Update Date | 2019-10-19 |