| NPI | 1962070912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MO 2021021831) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2021021831) |
| Enumeration Date | 2021-06-16 |
| Last Update Date | 2023-03-07 |