| NPI | 1982353306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME164450) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN35904) |
| Enumeration Date | 2022-03-22 |
| Last Update Date | 2026-08-31 |