| NPI | 1205520749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MO 2024025516) |
| Additional Taxonomies | 208D00000X General Practice (Licence: IA R-12839) |
| Enumeration Date | 2023-06-07 |
| Last Update Date | 2026-01-30 |