| NPI | 1134102254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AZ 30867) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 30867) |
| Enumeration Date | 2005-11-22 |
| Last Update Date | 2020-09-03 |