| NPI | 1538421961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207NP0225X Dermatology, Pediatric Dermatology (Licence: MA 270837) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MA 270837) |
| 207N00000X Dermatology (Licence: WI 61884 - 20) | |
| 207NP0225X Dermatology, Pediatric Dermatology (Licence: PA MD457272) | |
| 208000000X Pediatrics (Licence: MA L-251567) | |
| Enumeration Date | 2012-06-12 |
| Last Update Date | 2021-07-13 |