| NPI | 1033187273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: LA MD.04082R) |
| Additional Taxonomies | 174400000X Specialist (Licence: LA 04082R) |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2011-01-04 |