| NPI | 1982011797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MD D98480) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NH 18785) |
| Enumeration Date | 2014-07-14 |
| Last Update Date | 2023-09-27 |