| NPI | 1881694651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207NP0225X Dermatology Pediatric Dermatology (Licence: VA 0101041824) |
| Additional Taxonomies | 207NP0225X Dermatology Pediatric Dermatology (Licence: DC 16998) |
| 207NP0225X Dermatology Pediatric Dermatology (Licence: MD D0037284) | |
| Enumeration Date | 2005-07-22 |
| Last Update Date | 2007-07-08 |