| NPI | 1912905589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AZ 41219) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: PA MD 006191-E) |
| Enumeration Date | 2005-07-08 |
| Last Update Date | 2009-04-24 |