| NPI | 1902288806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MI 4301500350) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301108372) |
| Enumeration Date | 2015-06-26 |
| Last Update Date | 2019-10-23 |