| NPI | 1124333232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL OS11486) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: PA OT014922) |
| Enumeration Date | 2010-08-12 |
| Last Update Date | 2020-03-03 |