| NPI | 1932167384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WI 49751) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 1695) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2021-01-05 |