| NPI | 1760500813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WI 52541) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: PA MD424949) |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2013-02-27 |