| NPI | 1912384751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MD D89620) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX Q9509) |
| Enumeration Date | 2015-04-30 |
| Last Update Date | 2020-09-04 |