| NPI | 1669045654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WI PAR-0000974477) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WI 20977-40) |
| Enumeration Date | 2021-07-19 |
| Last Update Date | 2026-05-25 |