| NPI | 1326016742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: VT 042-0010696) |
| Additional Taxonomies | 174400000X Specialist (Licence: VT 0420010696) |
| Enumeration Date | 2006-03-10 |
| Last Update Date | 2021-09-08 |