| NPI | 1942230925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AZ 27555) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: UT 5663814-1205) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2015-11-12 |