| NPI | 1790761682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WI 19597-20) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WY 2751A) |
| 207N00000X Dermatology (Licence: MD D0067132) | |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2013-02-27 |