| NPI | 1598291361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: UT 11659150-1205) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 57079) |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2021-11-17 |