| NPI | 1467709972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CO DR.0053411) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TX P6857) |
| Enumeration Date | 2012-08-14 |
| Last Update Date | 2020-10-30 |