| NPI | 1093972325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: SC 37036) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: GA 73843) |
| Enumeration Date | 2008-05-22 |
| Last Update Date | 2021-05-13 |