| NPI | 1518042134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: LA MD.021909) |
| Additional Taxonomies | 207NP0225X Dermatology, Pediatric Dermatology (Licence: LA MD.021909) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2007-07-08 |