| NPI | 1881618304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 222467) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 222467-2) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2015-04-03 |