| NPI | 1649625351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CO DR.0071889) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MI 5101026324) |
| Enumeration Date | 2016-05-01 |
| Last Update Date | 2024-07-26 |