| NPI | 1750767638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AZ 006779) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: UT 3485941204) |
| Enumeration Date | 2015-08-03 |
| Last Update Date | 2025-03-10 |