| NPI | 1851368518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MD DD0096617) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: VA 0101237546) |
| Enumeration Date | 2006-03-01 |
| Last Update Date | 2026-08-06 |