| NPI | 1750394227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AZ 008872) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: ID O-1070) |
| 207N00000X Dermatology (Licence: OR DO150367) | |
| 207N00000X Dermatology (Licence: WA OP60762580) | |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2021-04-06 |