| NPI | 1801816715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX P5120) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0102201303) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2017-08-08 |