| NPI | 1386637122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MD D0020835) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WV 10481) |
| Enumeration Date | 2005-08-26 |
| Last Update Date | 2010-07-12 |