| NPI | 1346805090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: IA MD-55398) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CT 74955) |
| Enumeration Date | 2019-05-08 |
| Last Update Date | 2025-09-16 |