| NPI | 1336179340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WI 44786) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 44786) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2021-09-07 |