| NPI | 1952523474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MD H0075064) |
| Additional Taxonomies | 207NP0225X Dermatology, Pediatric Dermatology (Licence: PA OS014763) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2017-02-28 |