| NPI | 1124552336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OK 7206) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: VA 0116031529) |
| Enumeration Date | 2017-04-13 |
| Last Update Date | 2022-11-10 |