| NPI | 1134539638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NC 2018-01084) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 201131) |
| Enumeration Date | 2014-05-06 |
| Last Update Date | 2018-06-27 |