| NPI | 1003347519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A203497) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MD D0095080) |
| 207R00000X Internal Medicine (Licence: IL 125071373) | |
| 207R00000X Internal Medicine (Licence: IL 125.071373) | |
| Enumeration Date | 2017-03-26 |
| Last Update Date | 2025-07-22 |