| NPI | 1578788659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MA 242901) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NH 14398) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2010-11-18 |