| NPI | 1497884993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: VA 0101257093) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: KY 43422) |
| 207N00000X Dermatology (Licence: TN 49741) | |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2017-03-01 |