| NPI | 1710404082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL os21386) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: GA 86263) |
| Enumeration Date | 2017-08-27 |
| Last Update Date | 2024-12-09 |