| NPI | 1316942931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MN 20192) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: LA 011414) |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2008-11-20 |