| NPI | 1831176296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: VA 0102050026) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WV 1382) |
| Enumeration Date | 2005-12-28 |
| Last Update Date | 2026-08-03 |