| NPI | 1336178953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL OS8569) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: PA OS007565L) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2017-08-16 |