| NPI | 1386810588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: VA 0101261724) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NC 2008-01108) |
| Enumeration Date | 2008-05-07 |
| Last Update Date | 2023-02-22 |