| NPI | 1831105394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MT 18609) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: OR MD16342) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2023-10-25 |