| NPI | 1811969298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: KY 48569) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TN MD0000045837) |
| Enumeration Date | 2006-02-01 |
| Last Update Date | 2015-12-30 |