| NPI | 1215598065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX T9210) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2019020200) |
| Enumeration Date | 2019-06-24 |
| Last Update Date | 2023-03-27 |