| NPI | 1881014652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A156244) |
| Additional Taxonomies | 207NP0225X Dermatology, Pediatric Dermatology (Licence: CA A156244) |
| Enumeration Date | 2014-04-21 |
| Last Update Date | 2021-10-04 |