| NPI | 1780690875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: PA MD059207L) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD059207L) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2015-03-05 |