| NPI | 1902292394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: VA 0101269123) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 286353) |
| Enumeration Date | 2015-04-13 |
| Last Update Date | 2023-10-31 |