| NPI | 1295926574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX M9537) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: LA MD.201378) |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2013-07-18 |