| NPI | 1982342192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: KS 04-53525) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MO 2026035118) |
| Enumeration Date | 2022-05-26 |
| Last Update Date | 2026-08-19 |