| NPI | 1952581019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NC 2021-00937) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NE 24351) |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: NE 24351) | |
| Enumeration Date | 2007-11-06 |
| Last Update Date | 2024-11-15 |