| NPI | 1871888545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX P5691) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10039988) |
| Enumeration Date | 2011-06-10 |
| Last Update Date | 2019-10-16 |