| NPI | 1861445314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: IA 21731) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WI 23698) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2007-07-08 |