| NPI | 1861555237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NM A101294) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TX K6817) |
| 207N00000X Dermatology (Licence: AL D0417) | |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2007-07-08 |