| NPI | 1831325521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: DC MD047662) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 267210-1) |
| Enumeration Date | 2009-06-08 |
| Last Update Date | 2019-08-15 |