| NPI | 1568544088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AZ 43892) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: HI 13360) |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2013-01-02 |