| NPI | 1326337122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NM MD2016-0130) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MN 55575) |
| Enumeration Date | 2011-04-01 |
| Last Update Date | 2023-11-29 |