| NPI | 1689667313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WI 57672) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MA 744667) |
| Enumeration Date | 2005-08-29 |
| Last Update Date | 2021-09-13 |