| NPI | 1518228576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WI 66942-020) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: RI LP02597) |
| Enumeration Date | 2012-06-06 |
| Last Update Date | 2023-10-06 |