| NPI | 1982765525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA C53762) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 221825) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2009-08-13 |