| NPI | 1558658237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: UT 9342244-1205) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MN 105604) |
| 207N00000X Dermatology (Licence: MN 54498) | |
| Enumeration Date | 2011-07-01 |
| Last Update Date | 2017-08-14 |