| NPI | 1750769188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: KS 04-48164) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NC 2018-02215) |
| 207N00000X Dermatology (Licence: MO 2023031840) | |
| Enumeration Date | 2015-05-18 |
| Last Update Date | 2023-09-18 |