| NPI | 1669669867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: ID M-10075) |
| Additional Taxonomies | 208D00000X General Practice (Licence: ID m-10075) |
| Enumeration Date | 2007-10-02 |
| Last Update Date | 2025-02-12 |