| NPI | 1710514609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: UT 14293035-1205) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: GA 98882) |
| Enumeration Date | 2020-03-23 |
| Last Update Date | 2026-07-23 |