| NPI | 1649266792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AL AL21520) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL ME89393) |
| Enumeration Date | 2005-09-23 |
| Last Update Date | 2023-10-27 |