| NPI | 1629161476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: VA 0101258272) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NM MD20060477) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2023-08-09 |