| NPI | 1023505971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: VA 0101267699) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: OK 41401) |
| Enumeration Date | 2018-04-17 |
| Last Update Date | 2024-01-02 |