| NPI | 1265433494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AL MD.35820) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: UT 9412091-1205) |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2021-03-29 |