| NPI | 1720181639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: ID M-5749) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: ID M-5749) |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2011-12-19 |