| NPI | 1942204839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WI 22961) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: IA 22190) |
| Enumeration Date | 2005-06-08 |
| Last Update Date | 2014-02-05 |