| NPI | 1871817312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A130951) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TX P3510) |
| Enumeration Date | 2010-03-25 |
| Last Update Date | 2017-01-18 |