| NPI | 1962466961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX N8649) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WI 50083) |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2023-02-20 |