| NPI | 1871153551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NC 2025-02596) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC LL82772) |
| Enumeration Date | 2019-06-16 |
| Last Update Date | 2026-09-08 |