| NPI | 1669853552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX T1260) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MI 4301500695) |
| Enumeration Date | 2015-06-16 |
| Last Update Date | 2024-05-10 |