| NPI | 1063850600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A134026) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA L-255385) |
| Enumeration Date | 2013-06-05 |
| Last Update Date | 2021-05-06 |