| NPI | 1740030550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL 39950) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL 39950) |
| Enumeration Date | 2024-03-25 |
| Last Update Date | 2024-05-29 |