| NPI | 1861840290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MA 286736) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 304405) |
| Enumeration Date | 2016-05-26 |
| Last Update Date | 2022-08-26 |