| NPI | 1316904485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MD D0033313) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: VA 0101239815) |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2013-01-09 |