| NPI | 1104311075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL OS19219) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MI 5101024255) |
| 207N00000X Dermatology (Licence: MI 5151011340) | |
| Enumeration Date | 2018-06-24 |
| Last Update Date | 2023-08-30 |