| NPI | 1801247630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: UT 115759-8905) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 268357) |
| Enumeration Date | 2016-06-22 |
| Last Update Date | 2024-05-01 |