| NPI | 1518923432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA G80065) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: OH 35074557) |
| 207N00000X Dermatology (Licence: IN 01072447A) | |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2014-10-13 |