| NPI | 1063071199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MO 2023028374) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10068810) |
| Enumeration Date | 2019-06-12 |
| Last Update Date | 2024-05-07 |