| NPI | 1699711978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: LA 014095) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: AR R4035) |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2022-08-31 |