| NPI | 1295700987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A104512) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MN 47852) |
| 207N00000X Dermatology (Licence: AZ 36857) | |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2014-10-01 |