| NPI | 1699194530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NC 2023-01420) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: ID M-13761) |
| Enumeration Date | 2014-04-08 |
| Last Update Date | 2025-05-08 |