| NPI | 1942271812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AL 21157) |
| Additional Taxonomies | 207NP0225X Dermatology, Pediatric Dermatology (Licence: AL 21157) |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2010-04-14 |