| NPI | 1669598744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MI MC081921) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: UT 575-8827-1205) |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2025-05-29 |