| NPI | 1861465247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OR MD166259) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: OK 16880) |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2014-06-27 |