| NPI | 1063619484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AZ 40778) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 40778) |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2010-09-08 |