| NPI | 1730523093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME153527) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: IL 125062677) |
| 207R00000X Internal Medicine (Licence: IL 125062677) | |
| Enumeration Date | 2013-04-17 |
| Last Update Date | 2024-03-25 |