| NPI | 1356357289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME75435) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NM 2002-0127) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2010-11-11 |