| NPI | 1992715577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WI 19577) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MN 24193) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2019-05-29 |