| NPI | 1396987848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WI 57219) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: PA MT192569) |
| Enumeration Date | 2009-03-30 |
| Last Update Date | 2022-08-14 |