| NPI | 1710068556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA G55464) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: CA G55464) |
| 208D00000X General Practice (Licence: CA G55464) | |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2007-07-08 |