| NPI | 1194898551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MA 32183) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NH 10360) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2007-12-19 |