| NPI | 1669582474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME33970) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NC 22283) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2015-07-13 |