| NPI | 1013611326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: PA MT231413) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.082481) |
| Enumeration Date | 2023-03-29 |
| Last Update Date | 2024-06-21 |