| NPI | 1992829840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NC 2007-00984) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MI 4301075988) |
| Enumeration Date | 2007-03-18 |
| Last Update Date | 2010-12-30 |