| NPI | 1639159494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: VA 0102201119) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TN 4739) |
| 2083A0100X Preventive Medicine Aerospace Medicine (Licence: VA VA 0102201119) | |
| Enumeration Date | 2006-01-18 |
| Last Update Date | 2023-01-23 |