| NPI | 1639308943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NV 13147) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: AZ 65009) |
| Enumeration Date | 2009-07-08 |
| Last Update Date | 2023-01-23 |