| NPI | 1780670240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CT 048389) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: PA OS012763) |
| 207Q00000X Family Medicine (Licence: PA OS012763) | |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2012-01-05 |