| NPI | 1316912116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: PA MD037378L) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 119115-1) |
| Enumeration Date | 2006-02-23 |
| Last Update Date | 2007-07-08 |