| NPI | 1083682439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: VA 0101045546) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: RI MD12909) |
| 207N00000X Dermatology (Licence: RI CMD12909) | |
| Enumeration Date | 2006-03-10 |
| Last Update Date | 2024-01-02 |