| NPI | 1174014195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX T1547) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 208D00000X) |
| Enumeration Date | 2018-05-24 |
| Last Update Date | 2022-05-05 |