| NPI | 1275037806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WI 22333) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MN 67465) |
| Enumeration Date | 2018-03-20 |
| Last Update Date | 2023-02-02 |