| NPI | 1013411081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MN 65947) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MN 29223) |
| 207R00000X Internal Medicine (Licence: MN 29223) | |
| Enumeration Date | 2018-03-22 |
| Last Update Date | 2023-12-11 |