| NPI | 1023075710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NH 11723) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MA 220406) |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2015-01-06 |