| NPI | 1508857848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: PA MD426329) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MA 223638) |
| Enumeration Date | 2005-11-04 |
| Last Update Date | 2017-03-20 |