| NPI | 1811304009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AR E11476) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL UO4052) |
| Enumeration Date | 2014-07-19 |
| Last Update Date | 2018-07-13 |