| NPI | 1457606238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A129127) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A129127) |
| Enumeration Date | 2012-07-18 |
| Last Update Date | 2016-05-17 |