| NPI | 1295776870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: RI MD7404) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MA MD54155) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2007-07-10 |