| NPI | 1518950120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WI 21528020) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: AZ 7191) |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2008-04-20 |