| NPI | 1821248022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL OS10457) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS10457) |
| Enumeration Date | 2008-09-24 |
| Last Update Date | 2014-11-05 |