| NPI | 1063972040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CO DR.0072825) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: KS A6000567) |
| Enumeration Date | 2019-03-25 |
| Last Update Date | 2024-05-07 |