| NPI | 1467462515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MA 36176) |
| Additional Taxonomies | 174400000X Specialist (Licence: MA 36176) |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2009-03-18 |