| NPI | 1619503604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: PA MD495434) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD495434) |
| Enumeration Date | 2020-03-21 |
| Last Update Date | 2026-07-08 |