| NPI | 1942763941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL OS17969) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL 6696) |
| Enumeration Date | 2019-04-08 |
| Last Update Date | 2021-07-06 |