| NPI | 1104085216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX P2352) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MI 5101017631) |
| Enumeration Date | 2008-06-03 |
| Last Update Date | 2022-10-18 |