| NPI | 1447233754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WY 8097A) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA A55560) |
| Enumeration Date | 2005-11-22 |
| Last Update Date | 2014-08-04 |