| NPI | 1023338241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AZ 64080) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: VA 0101271283) |
| Enumeration Date | 2010-06-10 |
| Last Update Date | 2024-07-08 |