| NPI | 1194931907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: PA md435341) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: PA mt187716) |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2014-07-18 |