| NPI | 1558758839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CO Dr.0064778) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TN 59120) |
| Enumeration Date | 2015-04-23 |
| Last Update Date | 2020-10-07 |