| NPI | 1366433302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: VA 0101255078) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MA 218355) |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2023-11-27 |