| NPI | 1720119928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME117123) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WI 27846-020) |
| 207N00000X Dermatology (Licence: MO 2018016397) | |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2019-06-28 |