| NPI | 1790855955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A84390) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A84390) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2021-10-21 |