| NPI | 1558354407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MA 75666) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CT 042219) |
| 207N00000X Dermatology (Licence: RI 11477) | |
| Enumeration Date | 2005-08-25 |
| Last Update Date | 2023-11-28 |