| NPI | 1255650073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AZ 44434) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MN 57833) |
| Enumeration Date | 2010-05-18 |
| Last Update Date | 2020-03-11 |