| NPI | 1679157630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NC 2023-01305) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: ND 22670) |
| Enumeration Date | 2021-05-06 |
| Last Update Date | 2025-09-24 |