| NPI | 1629430210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WI 70104-20) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WI 6355-851) |
| Enumeration Date | 2016-03-23 |
| Last Update Date | 2020-07-23 |