| NPI | 1760451405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AL MD.25679) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: AL 00025679) |
| Enumeration Date | 2006-03-15 |
| Last Update Date | 2021-02-18 |