| NPI | 1629070495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MD D0075780) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101232096) |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2017-10-25 |