| NPI | 1063747178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: PA MD453980) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NC 2012-01176) |
| Enumeration Date | 2009-10-07 |
| Last Update Date | 2015-06-01 |