| NPI | 1083877393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA C154031) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MA 253116) |
| 207N00000X Dermatology (Licence: MO 2009010233) | |
| 207R00000X Internal Medicine (Licence: IL 125055212) | |
| Enumeration Date | 2008-07-07 |
| Last Update Date | 2018-07-12 |