| NPI | 1134289648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: DC MD12541) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: VA 0101032702) |
| 207R00000X Internal Medicine (Licence: MD D25896) | |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2022-01-24 |