| NPI | 1083889885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: PA MD439749) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NC 127797) |
| Enumeration Date | 2008-04-23 |
| Last Update Date | 2020-08-06 |