| NPI | 1700148277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: VA 0101254438) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NH 20101) |
| Enumeration Date | 2012-06-11 |
| Last Update Date | 2020-03-06 |