| NPI | 1790217768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WI 22880) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL ME137216) |
| 207N00000X Dermatology (Licence: MN 69383) | |
| 207N00000X Dermatology (Licence: MN 30542) | |
| 207R00000X Internal Medicine (Licence: FL TRN24553) | |
| Enumeration Date | 2017-03-29 |
| Last Update Date | 2024-01-22 |