| NPI | 1275072365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: GA 95786) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: SC 89287) |
| 207N00000X Dermatology (Licence: VA 0101266064) | |
| Enumeration Date | 2017-02-22 |
| Last Update Date | 2025-08-07 |