| NPI | 1790147650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 308011) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MA 282666) |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2021-07-07 |