| NPI | 1629451141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NC 201901147) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC LL38257) |
| Enumeration Date | 2015-07-01 |
| Last Update Date | 2019-07-11 |