| NPI | 1770565384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MI 5101020217) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: GA 055534) |
| Enumeration Date | 2005-11-18 |
| Last Update Date | 2013-07-24 |