| NPI | 1326331653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MA 294885) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: VT 042.0014379) |
| Enumeration Date | 2011-05-19 |
| Last Update Date | 2022-12-19 |