| NPI | 1528407780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA 150337) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA 150337) |
| Enumeration Date | 2013-06-21 |
| Last Update Date | 2022-08-04 |