| NPI | 1932764263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MO 2024023117) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TX BP10067723) |
| Enumeration Date | 2019-05-02 |
| Last Update Date | 2025-01-21 |