| NPI | 1912436106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MI 4301503777) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MI 4301112247) |
| Enumeration Date | 2017-06-09 |
| Last Update Date | 2021-07-12 |