| NPI | 1912904970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MN 41400) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WI 51009) |
| 207N00000X Dermatology (Licence: SD 4426) | |
| Enumeration Date | 2005-07-06 |
| Last Update Date | 2018-09-20 |