| NPI | 1306067640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AZ 64411) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: VA 0101262728) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2024-04-23 |