| NPI | 1780831180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL OS10399) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 242523) |
| Enumeration Date | 2008-08-27 |
| Last Update Date | 2011-11-02 |