| NPI | 1871792820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WA MD60454736) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: HI MD15039) |
| Enumeration Date | 2007-07-11 |
| Last Update Date | 2014-06-18 |