| NPI | 1770748303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WI 57069-20) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: IA R-8552) |
| Enumeration Date | 2008-07-23 |
| Last Update Date | 2021-09-10 |