| NPI | 1730671645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OR MD211861) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT215448) |
| Enumeration Date | 2018-06-06 |
| Last Update Date | 2023-02-10 |