| NPI | 1639171176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: KY 16820) |
| Additional Taxonomies | 174400000X Specialist (Licence: KY KY16820) |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2012-12-06 |