| NPI | 1912164872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A123791) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 250356) |
| Enumeration Date | 2008-05-19 |
| Last Update Date | 2021-09-02 |