| NPI | 1033289020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NH 82076958) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: VT 0006958) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2023-03-07 |