| NPI | 1306387584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: DC MD210002140) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MA 274936) |
| Enumeration Date | 2017-03-20 |
| Last Update Date | 2026-06-29 |