| NPI | 1598740532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: KY 41614) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TN 49149) |
| Enumeration Date | 2005-12-13 |
| Last Update Date | 2015-01-02 |