| NPI | 1053592840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MS 21371) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: LA MD.201654) |
| Enumeration Date | 2007-11-20 |
| Last Update Date | 2020-08-03 |