| NPI | 1285669002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NC 2012-00923) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WV 21585) |
| 207R00000X Internal Medicine (Licence: WV 21585) | |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2015-02-09 |