| NPI | 1932488574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 279602) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CO DR.0055946) |
| Enumeration Date | 2011-08-14 |
| Last Update Date | 2023-12-13 |