| NPI | 1154534741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX N2835) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: AZ 36905) |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2020-12-30 |