| NPI | 1538371133 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MT 12373) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: ND 21960) |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2024-12-31 |