| NPI | 1952678278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ZZ MSAS 43258) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: ZZ CM17354) |
| Enumeration Date | 2011-12-01 |
| Last Update Date | 2011-12-02 |