| NPI | 1972669455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: IN 71001628A) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AZ AP4948) |
| 207N00000X Dermatology (Licence: AZ AZ4948) | |
| 363L00000X Nurse Practitioner (Licence: IN 71001628A) | |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2020-10-07 |