| NPI | 1952030157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MI 4351050456) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT226922) |
| Enumeration Date | 2022-06-06 |
| Last Update Date | 2023-10-26 |