| NPI | 1992755813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NE 21603) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NE MD26977) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2007-07-08 |