| NPI | 1598732489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: IA 22086) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WI 24706-20) |
| Enumeration Date | 2006-03-01 |
| Last Update Date | 2012-12-12 |