| NPI | 1720085582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NE 18783) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: IA 28654) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2012-04-03 |