| NPI | 1396823142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: VA 0101261503) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TN 020693) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2020-12-10 |