| NPI | 1508858192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NV 17074) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV 9723) |
| 207N00000X Dermatology (Licence: NV 9723) | |
| Enumeration Date | 2005-08-19 |
| Last Update Date | 2019-03-18 |