| NPI | 1053436261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WV 10935) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: PA MD026005E) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2019-07-22 |