| NPI | 1437102324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WI 74824) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MN 64615) |
| 207N00000X Dermatology (Licence: ND 10214) | |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2025-12-04 |