| NPI | 1568789550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX Q9307) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD P25275) |
| Enumeration Date | 2010-04-29 |
| Last Update Date | 2023-09-08 |