| NPI | 1689757973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: UT 7161158-1205) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WI 49974) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2023-11-27 |