| NPI | 1013146836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MN 54243) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 54243) |
| Enumeration Date | 2009-07-14 |
| Last Update Date | 2020-08-20 |