| NPI | 1790886455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 023474) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: VT 0550031419) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2021-09-08 |