| NPI | 1609396845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AK 241077) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NE 1928) |
| Enumeration Date | 2017-06-20 |
| Last Update Date | 2025-08-13 |