| NPI | 1497709778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NC 2007-01406) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MI 5101013247) |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2008-02-20 |