| NPI | 1063419307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX K3730) |
| Additional Taxonomies | 174400000X Specialist (Licence: AR C8433) |
| Enumeration Date | 2005-07-01 |
| Last Update Date | 2024-06-12 |