| NPI | 1598769473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MO 114816) |
| Additional Taxonomies | 174400000X Specialist (Licence: MO 114816) |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2020-10-14 |