| NPI | 1972363133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MN 80269) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 34195) |
| Enumeration Date | 2024-03-22 |
| Last Update Date | 2025-08-01 |