| NPI | 1972962710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NC 2021-03162) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: PA OS020540) |
| Enumeration Date | 2016-02-22 |
| Last Update Date | 2021-12-29 |