| NPI | 1871595082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NC 39543) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 39543) |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2023-08-10 |