| NPI | 1073692380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: UT 64960371205) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WI 47518020) |
| 207N00000X Dermatology (Licence: NV 12215) | |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2008-06-03 |