| NPI | 1023128345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL MD91126) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NV 26355) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2025-02-17 |