| NPI | 1548935216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME160236) |
| Additional Taxonomies | 207NP0225X Dermatology, Pediatric Dermatology (Licence: AZ 65654) |
| Enumeration Date | 2021-08-13 |
| Last Update Date | 2024-10-11 |