| NPI | 1861856551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: PR 021312) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 021312) |
| Enumeration Date | 2016-04-08 |
| Last Update Date | 2023-08-25 |