| NPI | 1538264098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MA 59196) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NH 7901) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2013-05-16 |