| NPI | 1548266554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: KS 22396) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MO RJ47) |
| Enumeration Date | 2005-06-23 |
| Last Update Date | 2020-02-20 |