| NPI | 1386082873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MA 270922) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 255228) |
| Enumeration Date | 2013-06-06 |
| Last Update Date | 2017-08-03 |