| NPI | 1902841992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 152624) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NH LT4168) |
| 207N00000X Dermatology (Licence: MN 70092) | |
| Enumeration Date | 2006-06-17 |
| Last Update Date | 2021-11-09 |