| NPI | 1396278099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MI 4301504882) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MI 4301114438) |
| 207R00000X Internal Medicine (Licence: IL 125.070725) | |
| Enumeration Date | 2017-04-10 |
| Last Update Date | 2021-08-31 |