| NPI | 1578855300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME119801) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN16050) |
| Enumeration Date | 2011-05-12 |
| Last Update Date | 2019-08-26 |