| NPI | 1164622981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NH 15186) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: VA 0101236793) |
| Enumeration Date | 2007-07-19 |
| Last Update Date | 2025-11-10 |