| NPI | 1497805071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MN 60390) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 50184-21) |
| 207N00000X Dermatology (Licence: WI 50184-21) | |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2020-07-22 |