| NPI | 1497103105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A150395) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MD D87162) |
| Enumeration Date | 2016-06-03 |
| Last Update Date | 2024-10-22 |