| NPI | 1104146000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX P7830) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX P7830) |
| Enumeration Date | 2010-06-03 |
| Last Update Date | 2021-12-22 |