| NPI | 1013170125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: ID M-11026) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL ME104994) |
| Enumeration Date | 2008-07-08 |
| Last Update Date | 2013-02-07 |