| NPI | 1821520115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: LA 320806) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA 320806) |
| Enumeration Date | 2017-03-28 |
| Last Update Date | 2022-04-21 |