| NPI | 1457702383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A172548) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 267576) |
| Enumeration Date | 2016-06-22 |
| Last Update Date | 2022-10-13 |