| NPI | 1487946026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MN 55584) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MN 106319) |
| Enumeration Date | 2011-05-13 |
| Last Update Date | 2023-12-05 |