| NPI | 1144587353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: SD 10054) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MN 56956) |
| 207N00000X Dermatology (Licence: MN 107012) | |
| Enumeration Date | 2012-04-12 |
| Last Update Date | 2020-10-14 |