| NPI | 1588142517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MO 2023031523) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: KS 04-48094) |
| Enumeration Date | 2018-08-01 |
| Last Update Date | 2025-12-01 |