| NPI | 1194248013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MN 70700) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WI 71434-20) |
| 207N00000X Dermatology (Licence: WI 7125-851) | |
| Enumeration Date | 2017-07-23 |
| Last Update Date | 2023-02-22 |