| NPI | 1881691715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207N00000X Dermatology (Licence: DC MD25652) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MD D0013967) |
| 207N00000X Dermatology (Licence: CA C310116) | |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2007-07-08 |