| NPI | 1982678173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AZ 18074) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MN 20146) |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2013-04-10 |