| NPI | 1194285072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: DC MD600004150) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: VA 0101277702) |
| Enumeration Date | 2019-03-25 |
| Last Update Date | 2025-06-25 |