| NPI | 1811950074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CT 52390) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TN MD40790) |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2014-11-25 |