| NPI | 1285752998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MI 5101016359) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MT MED-PHYS-LIC-167368) |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2026-04-15 |