| NPI | 1568783595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX P9970) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10037112) |
| Enumeration Date | 2010-06-14 |
| Last Update Date | 2021-03-02 |