| NPI | 1619311164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207NP0225X Dermatology Pediatric Dermatology (Licence: CA A148597) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA A148597) |
| Enumeration Date | 2013-04-25 |
| Last Update Date | 2018-07-13 |