| NPI | 1306067640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MO 2025004026) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2025004026) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2025-07-16 |