| NPI | 1912132523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX P3343) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX P3343) |
| Enumeration Date | 2009-05-27 |
| Last Update Date | 2018-03-17 |