| NPI | 1649357690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AR R-4149) |
| Additional Taxonomies | 174400000X Specialist (Licence: AR R4149) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2021-11-18 |