| NPI | 1265896633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CO DR.0065875) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MD D89077) |
| Enumeration Date | 2016-04-11 |
| Last Update Date | 2021-08-21 |