| NPI | 1689801789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MD D0092595) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WI 66765) |
| 207N00000X Dermatology (Licence: MI 4301501511) | |
| 207N00000X Dermatology (Licence: TX Q6738) | |
| 207N00000X Dermatology (Licence: NE 25810) | |
| 207N00000X Dermatology (Licence: MN 61522) | |
| Enumeration Date | 2009-06-16 |
| Last Update Date | 2023-03-07 |