| NPI | 1801384029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OH 35.148134) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: GA 10741) |
| 207N00000X Dermatology (Licence: VA 0101274667) | |
| Enumeration Date | 2018-04-23 |
| Last Update Date | 2023-11-06 |