| NPI | 1417944349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MN 29881) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: AZ 21367) |
| Enumeration Date | 2005-10-05 |
| Last Update Date | 2019-12-04 |