NPI | 1982164273 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME161565) |
Additional Taxonomies | 207N00000X Dermatology (Licence: WA MD61643625) |
Enumeration Date | 2019-03-22 |
Last Update Date | 2025-07-07 |