| NPI | 1699201855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CO DR.0073931) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NC 2021-01723) |
| Enumeration Date | 2017-05-10 |
| Last Update Date | 2025-01-29 |