| NPI | 1063804441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NH 20656) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: VA 0102205027) |
| Enumeration Date | 2015-02-23 |
| Last Update Date | 2021-04-05 |