| NPI | 1629394713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: KY 46666) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 164546) |
| Enumeration Date | 2010-04-14 |
| Last Update Date | 2015-08-17 |