| NPI | 1063425791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TN DO0000000839) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TN DO0000000839) |
| 207K00000X Allergy & Immunology (Licence: TN DO0000000839) | |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2015-09-10 |