| NPI | 1386696904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX M1072) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX M1072) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2021-09-09 |