| NPI | 1023548575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ R76146) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TX S) |
| Enumeration Date | 2017-06-18 |
| Last Update Date | 2022-02-23 |