| NPI | 1396748950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207NP0225X Dermatology Pediatric Dermatology (Licence: PA MD057630L) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: PA MD057630L) |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2007-07-08 |