| NPI | 1679558027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL MFC1766) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NC 200500348) |
| 207N00000X Dermatology (Licence: PA MD449759) | |
| Enumeration Date | 2005-12-08 |
| Last Update Date | 2016-09-01 |