| NPI | 1528217395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NE 26614) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: OK 27129) |
| Enumeration Date | 2008-09-16 |
| Last Update Date | 2026-05-21 |