| NPI | 1073714499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CO DR.0075471) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TX M9728) |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2025-08-14 |