| NPI | 1386934933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NC 2016-02183) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: GA 072838) |
| 207N00000X Dermatology (Licence: FL ME121327) | |
| 207N00000X Dermatology (Licence: SC 37485) | |
| 207N00000X Dermatology (Licence: TX P8091) | |
| Enumeration Date | 2011-04-17 |
| Last Update Date | 2017-11-02 |