| NPI | 1366441560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NC 9500935) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 9500935) |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2009-08-20 |