| NPI | 1669433413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: VT 042.0012583) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 259729) |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2013-07-17 |