| NPI | 1164459319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AZ 33324) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: AZ 33324) |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2011-11-10 |