| NPI | 1871676148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CO 48544) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MO 2007012256) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2021-06-12 |