| NPI | 1225664675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: VA 0101272997) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: VA 0101272997) |
| Enumeration Date | 2020-03-18 |
| Last Update Date | 2025-10-08 |