| NPI | 1033169610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MA 74628) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NH 9870) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2015-10-14 |