| NPI | 1861495061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: PA MD018193E) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WI 60705 - 20) |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2024-11-30 |