| NPI | 1033101175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL OS7092) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NC 2014-00246) |
| 207Q00000X Family Medicine (Licence: FL OS0007092) | |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2020-11-23 |