| NPI | 1548827710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: GA 98733) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MI 5101026012) |
| 207N00000X Dermatology (Licence: GA 15530) | |
| 207N00000X Dermatology (Licence: FL 20723) | |
| Enumeration Date | 2019-05-23 |
| Last Update Date | 2024-02-12 |