| NPI | 1508864927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: SC 06954) |
| Additional Taxonomies | 174400000X Specialist (Licence: SC 06954) |
| Enumeration Date | 2005-07-10 |
| Last Update Date | 2022-11-14 |