| NPI | 1669479366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX K9148) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX K9148) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2016-09-21 |