| NPI | 1972690816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MD D68469) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MI 4301059208) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2022-09-13 |