| NPI | 1053897892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: SD 14265) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MI 4301507145) |
| Enumeration Date | 2018-07-16 |
| Last Update Date | 2023-06-22 |