| NPI | 1003171109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MN 60548) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MN 60548) |
| Enumeration Date | 2012-07-05 |
| Last Update Date | 2022-02-04 |