| NPI | 1962578617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: RI RI4029) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MA 28301) |
| Enumeration Date | 2006-11-27 |
| Last Update Date | 2011-03-24 |