| NPI | 1962909937 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WI 22314) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MN 65784) |
| Enumeration Date | 2018-04-06 |
| Last Update Date | 2022-06-29 |