| NPI | 1073193827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MO 2024024963) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TX BP20081808) |
| Enumeration Date | 2021-04-14 |
| Last Update Date | 2024-08-13 |