| NPI | 1588703524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX M6234) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NM 132006) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2021-06-18 |