| NPI | 1982132510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: KS 05-44847) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: VA 0102205409) |
| Enumeration Date | 2017-05-26 |
| Last Update Date | 2025-06-06 |