| NPI | 1073635355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NH RT 1740) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NH 14091) |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2010-03-18 |