| NPI | 1396749347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: HI MD12517) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TX F9684) |
| 207N00000X Dermatology (Licence: WA MD60199612) | |
| Enumeration Date | 2005-06-08 |
| Last Update Date | 2015-01-27 |