| NPI | 1265595243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: SC 52008) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NC 2006-1676) |
| 207Q00000X Family Medicine (Licence: NC 2006-1676) | |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2019-05-29 |