| NPI | 1902054125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A114406) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MN 104036) |
| 207N00000X Dermatology (Licence: MN 51413) | |
| Enumeration Date | 2008-08-29 |
| Last Update Date | 2021-12-03 |