| NPI | 1639173370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AZ 44982) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 44982) |
| Enumeration Date | 2005-06-10 |
| Last Update Date | 2019-04-11 |