| NPI | 1275196784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: UT 132671711205) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: AZ R77338) |
| 207N00000X Dermatology (Licence: AZ 67691) | |
| Enumeration Date | 2019-04-19 |
| Last Update Date | 2023-05-04 |