| NPI | 1174538912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: KY 33806) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: IN 01041935) |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2018-07-17 |