| NPI | 1578395992 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL PA9118272) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL PA9118272) |
| Enumeration Date | 2024-08-14 |
| Last Update Date | 2025-03-09 |