| NPI | 1104814102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA G58292) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: UT 330766827) |
| 207N00000X Dermatology (Licence: NV 18908) | |
| 207N00000X Dermatology (Licence: UT 3673151205) | |
| 207N00000X Dermatology (Licence: AZ 22469) | |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2023-03-07 |