| NPI | 1023201977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0102206014) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MI 5101017531) |
| Enumeration Date | 2007-08-23 |
| Last Update Date | 2022-02-17 |