| NPI | 1770926255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: VA 0101262483) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: DC MD045252) |
| Enumeration Date | 2013-04-15 |
| Last Update Date | 2021-04-16 |