| NPI | 1700835675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A92405) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: IA 36475) |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2014-11-20 |