| NPI | 1013924588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: VA 0101033944) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101033944) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2014-06-11 |