| NPI | 1013097419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207NP0225X Dermatology, Pediatric Dermatology (Licence: TX F4210) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TX F4210) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2012-01-10 |