| NPI | 1932314960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL OS 8762) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 229435) |
| 207NP0225X Dermatology, Pediatric Dermatology (Licence: FL OS 8762) | |
| 207NP0225X Dermatology, Pediatric Dermatology (Licence: NY 229435) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: FL OS 8762) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: NY 229435) | |
| Enumeration Date | 2007-05-12 |
| Last Update Date | 2015-03-20 |