| NPI | 1174722292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: KS 0434494) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MO 2010020698) |
| Enumeration Date | 2007-07-18 |
| Last Update Date | 2014-06-18 |