| NPI | 1548211345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME58118) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL FLME0058118) |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2014-11-18 |