| NPI | 1467650325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MI 5101017387) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101017387) |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2024-01-10 |