| NPI | 1871589259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: PA OS009236L) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS009236L) |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2025-03-25 |