| NPI | 1598839813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: PA MD440722) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA A73182) |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2012-12-14 |