| NPI | 1538330238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AL 30863) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CO 2653) |
| 207R00000X Internal Medicine (Licence: VA 0116019329) | |
| Enumeration Date | 2008-03-20 |
| Last Update Date | 2021-04-21 |