| NPI | 1154068864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AZ 012385) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MI 5151015560) |
| Enumeration Date | 2022-05-14 |
| Last Update Date | 2026-06-23 |