| NPI | 1073903290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NC 314704) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MI 4301506008) |
| 207N00000X Dermatology (Licence: MD D0091410) | |
| Enumeration Date | 2015-01-26 |
| Last Update Date | 2023-07-20 |