| NPI | 1003311960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A173403) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NV 20563) |
| Enumeration Date | 2018-03-23 |
| Last Update Date | 2025-03-26 |