| NPI | 1588627244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: LA 12278R) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MS 15605) |
| 207N00000X Dermatology (Licence: CA G81348) | |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2013-09-11 |