| NPI | 1013973163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX F2179) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX F2179) |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2008-02-29 |