| NPI | 1649450172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MI 4301069064) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TX K9972) |
| 207N00000X Dermatology (Licence: FL ME115217) | |
| 207N00000X Dermatology (Licence: AR E-9369) | |
| Enumeration Date | 2007-11-13 |
| Last Update Date | 2024-05-13 |