| NPI | 1437396116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX T4301) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WI 65778) |
| 207N00000X Dermatology (Licence: MO 2013034091) | |
| Enumeration Date | 2009-01-16 |
| Last Update Date | 2023-03-30 |