| NPI | 1811013576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: KS 33069) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MI 5101016672) |
| 207N00000X Dermatology (Licence: MO 2008004467) | |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2023-05-15 |