| NPI | 1023698735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MN 71968) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 31572) |
| Enumeration Date | 2021-04-08 |
| Last Update Date | 2023-12-12 |