| NPI | 1083839138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: RI MD12887) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CT 50241) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2018-12-05 |