| NPI | 1689856049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CT 48603) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CT 390200000X) |
| Enumeration Date | 2007-11-28 |
| Last Update Date | 2015-08-24 |