| NPI | 1063851871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: UT 10232794-1204) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: OR PG163800) |
| Enumeration Date | 2013-06-14 |
| Last Update Date | 2022-07-21 |