| NPI | 1194707489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MA 34825) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 34825) |
| Enumeration Date | 2005-11-14 |
| Last Update Date | 2012-07-23 |