| NPI | 1235403916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MN 73708) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MD D83742) |
| Enumeration Date | 2012-02-28 |
| Last Update Date | 2023-08-02 |