| NPI | 1316395601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AL 39100) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: AR E-12641) |
| Enumeration Date | 2016-05-27 |
| Last Update Date | 2022-01-05 |