| NPI | 1114548864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL OS20820) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MI 5151014311) |
| Enumeration Date | 2020-05-05 |
| Last Update Date | 2024-06-19 |