| NPI | 1427074517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MD D69136) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: PA MD426253) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2013-02-06 |