| NPI | 1245454404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: LA 203620) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: LA e-6101) |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2013-06-25 |