| NPI | 1265705933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AK 115179) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NE 1090) |
| Enumeration Date | 2012-02-10 |
| Last Update Date | 2023-07-13 |