| NPI | 1376800532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: UT 9791675-1205) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NV 16478) |
| Enumeration Date | 2012-04-12 |
| Last Update Date | 2016-09-27 |