| NPI | 1902084296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MA 262096) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CT 050055) |
| Enumeration Date | 2008-02-08 |
| Last Update Date | 2015-06-09 |