| NPI | 1235588658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: UT 11768461-1204) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: OR PG177161) |
| Enumeration Date | 2016-06-07 |
| Last Update Date | 2023-11-08 |