| NPI | 1093977985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MI 5101015228) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: IA 4074) |
| Enumeration Date | 2008-07-01 |
| Last Update Date | 2011-11-18 |