| NPI | 1225440324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: ND 15560) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: KY 51443) |
| Enumeration Date | 2014-05-22 |
| Last Update Date | 2023-05-15 |