| NPI | 1902879687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX N0043) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: PA MD427324) |
| Enumeration Date | 2006-02-11 |
| Last Update Date | 2016-11-09 |