| NPI | 1962883165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MO 2018023418) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2018023418) |
| Enumeration Date | 2015-06-12 |
| Last Update Date | 2025-04-17 |