| NPI | 1275161259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MN 69685) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 30789) |
| Enumeration Date | 2020-03-27 |
| Last Update Date | 2021-07-15 |