| NPI | 1891350443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: VA 0101278368) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NC 2025-02864) |
| Enumeration Date | 2019-05-08 |
| Last Update Date | 2025-10-09 |