| NPI | 1861837551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: PA MD476421) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 294232) |
| Enumeration Date | 2013-05-08 |
| Last Update Date | 2022-05-17 |