| NPI | 1417184144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MA 256901) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 240628) |
| Enumeration Date | 2009-06-21 |
| Last Update Date | 2014-10-20 |