| NPI | 1518454669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL 6875) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR 188518) |
| Enumeration Date | 2018-04-15 |
| Last Update Date | 2020-08-03 |