| NPI | 1952317505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WY 3201A) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CO 34844) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2012-10-15 |