| NPI | 1669823357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MI 4301510408) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT211930) |
| Enumeration Date | 2016-06-24 |
| Last Update Date | 2024-05-12 |