| NPI | 1033259320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NC 2008-00827) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: KY IP859) |
| 207N00000X Dermatology (Licence: HI 14758) | |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2011-08-17 |