| NPI | 1417510090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MD D0105324) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MA MCS012397A) |
| Enumeration Date | 2019-04-18 |
| Last Update Date | 2025-11-18 |