| NPI | 1205191400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MD D83592) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.1361789) |
| Enumeration Date | 2012-07-12 |
| Last Update Date | 2019-03-13 |