| NPI | 1104452366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MD D0094136) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MD D0094136) |
| Enumeration Date | 2020-03-19 |
| Last Update Date | 2024-07-07 |