| NPI | 1679581318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: VA 0101049323) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NC 36846) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2023-03-07 |