| NPI | 1376925842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AZ 010156) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NE 1531) |
| 208D00000X General Practice (Licence: NE 1531) | |
| Enumeration Date | 2015-06-22 |
| Last Update Date | 2024-03-21 |