| NPI | 1518306588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MA 269832) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 255428) |
| Enumeration Date | 2013-06-22 |
| Last Update Date | 2022-07-21 |