| NPI | 1720188196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AL 10825) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: AR N5894) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2013-01-09 |