| NPI | 1306340914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME160960) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.071992) |
| Enumeration Date | 2018-03-19 |
| Last Update Date | 2023-06-07 |