| NPI | 1831382811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 063000) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: GA 063000) |
| 207N00000X Dermatology (Licence: SC TL31754) | |
| 207Q00000X Family Medicine (Licence: SC TL31754) | |
| Enumeration Date | 2007-08-22 |
| Last Update Date | 2021-03-31 |