| NPI | 1720594500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MN 1007) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: MN 1007) |
| Enumeration Date | 2017-12-16 |
| Last Update Date | 2017-12-16 |