| NPI | 1710997200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: ID M-16045) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AL 15081) |
| 207R00000X Internal Medicine (Licence: ID M-16045) | |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2023-09-19 |