| NPI | 1164401675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AZ 18686) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MN 25472) |
| Enumeration Date | 2006-01-12 |
| Last Update Date | 2020-09-03 |