| NPI | 1851747695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WI 84690) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TN 61127) |
| Enumeration Date | 2016-05-11 |
| Last Update Date | 2024-12-09 |