| NPI | 1316444565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: GA 92896) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: LA 320110) |
| Enumeration Date | 2018-04-12 |
| Last Update Date | 2022-07-29 |