| NPI | 1942265673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MA 73772) |
| Additional Taxonomies | 174400000X Specialist (Licence: MA 73772) |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2010-12-09 |