| NPI | 1376805812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: VA 1376805821) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT014572) |
| Enumeration Date | 2012-06-11 |
| Last Update Date | 2021-10-19 |