| NPI | 1932109824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX F5172) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX F5172) |
| Enumeration Date | 2005-07-21 |
| Last Update Date | 2016-12-15 |