| NPI | 1477818920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: UT 11293840-1204) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WA OP 60613648) |
| 207N00000X Dermatology (Licence: ID O-0902) | |
| Enumeration Date | 2012-07-11 |
| Last Update Date | 2024-05-15 |