| NPI | 1407177538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OK 30827) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX p6446) |
| Enumeration Date | 2010-06-11 |
| Last Update Date | 2014-06-17 |