| NPI | 1235450479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL me153859) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: PA MD451623) |
| 207N00000X Dermatology (Licence: CT 56827) | |
| Enumeration Date | 2010-06-22 |
| Last Update Date | 2022-11-12 |