| NPI | 1134790157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: RI MD19412) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI LP05421) |
| Enumeration Date | 2021-07-09 |
| Last Update Date | 2023-07-18 |