| NPI | 1689335911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL PA9116928) |
| Additional Taxonomies | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: FL PA9116928) |
| 207N00000X Dermatology (Licence: VA 0110008816) | |
| Enumeration Date | 2022-01-08 |
| Last Update Date | 2026-08-20 |