| NPI | 1801893607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AZ 308999) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 126210-1) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2017-03-01 |