| NPI | 1669609665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: SC 35440) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10034608) |
| Enumeration Date | 2009-06-17 |
| Last Update Date | 2014-07-01 |