| NPI | 1891311403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MO 2020017468) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: IA R-12019) |
| Enumeration Date | 2020-06-19 |
| Last Update Date | 2024-03-18 |