| NPI | 1972064574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME165968) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TN 67166) |
| Enumeration Date | 2019-03-27 |
| Last Update Date | 2024-05-22 |