| NPI | 1326578790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: VA 0101275393) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 289740) |
| 207R00000X Internal Medicine (Licence: MA 271921) | |
| Enumeration Date | 2017-06-18 |
| Last Update Date | 2022-07-15 |