| NPI | 1639121304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: ND 10119) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MN 45261) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2022-02-08 |