| NPI | 1457766487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CO DR.0059273) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL OS13474) |
| Enumeration Date | 2014-06-28 |
| Last Update Date | 2021-09-27 |