| NPI | 1528459815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CO DR.0067923) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: UT 12192581-1205) |
| Enumeration Date | 2015-02-09 |
| Last Update Date | 2025-09-10 |