| NPI | 1548642135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MO 2022024230) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MA 283686) |
| 207N00000X Dermatology (Licence: MO 2015017272) | |
| Enumeration Date | 2015-06-19 |
| Last Update Date | 2022-07-06 |