| NPI | 1720046386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: LA 308461) |
| Additional Taxonomies | 174400000X Specialist (Licence: AZ 28252) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2018-10-01 |