| NPI | 1497021554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: PA MD455798) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MD455798) |
| Enumeration Date | 2012-03-22 |
| Last Update Date | 2021-09-09 |