| NPI | 1831480524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TN 59143) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 286903) |
| Enumeration Date | 2011-04-28 |
| Last Update Date | 2023-04-05 |