| NPI | 1639309941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WI 65695-20) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MT194861) |
| Enumeration Date | 2009-07-21 |
| Last Update Date | 2025-04-01 |