| NPI | 1942731674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: VA 0116030218) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: AR E-13799) |
| Enumeration Date | 2017-03-24 |
| Last Update Date | 2024-08-21 |