| NPI | 1104262526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OK 30040) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OK 30040) |
| Enumeration Date | 2013-05-13 |
| Last Update Date | 2017-07-14 |