| NPI | 1710333414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: KS 04-45508) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MO 2022012327) |
| Enumeration Date | 2016-05-11 |
| Last Update Date | 2022-09-12 |