| NPI | 1609813237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MA 209782) |
| Additional Taxonomies | 207NP0225X Dermatology, Pediatric Dermatology (Licence: MA 209782) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2022-11-21 |