| NPI | 1790946903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OR MD175789) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: VA 0101255893) |
| Enumeration Date | 2008-06-19 |
| Last Update Date | 2016-03-22 |