| NPI | 1790196525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: VT 042.0014118) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 295329) |
| Enumeration Date | 2014-05-14 |
| Last Update Date | 2018-08-28 |