| NPI | 1407037237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: PA OS014279) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101015738) |
| Enumeration Date | 2007-11-20 |
| Last Update Date | 2018-08-27 |