| NPI | 1003484346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA 180038) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2021021426) |
| Enumeration Date | 2021-06-14 |
| Last Update Date | 2022-07-04 |