| NPI | 1215102041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL os9835) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL os9835) |
| Enumeration Date | 2008-04-23 |
| Last Update Date | 2011-09-06 |