| NPI | 1629275037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MT 91667) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: UT 8128676-1205) |
| 207R00000X Internal Medicine (Licence: AZ 81956) | |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2021-11-30 |