| NPI | 1386938694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: PA MD454673) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NC 2020-02431) |
| Enumeration Date | 2011-06-03 |
| Last Update Date | 2022-08-24 |