| NPI | 1972552545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: PA MD464849) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MD D62336) |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2021-08-25 |