| NPI | 1083061048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: PA MD469262) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT210890) |
| Enumeration Date | 2016-05-19 |
| Last Update Date | 2021-11-09 |