| NPI | 1376807917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MO 2018013045) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: KS 04-38810) |
| Enumeration Date | 2012-06-28 |
| Last Update Date | 2023-02-24 |