| NPI | 1134568785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MA 274413) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MA 255159) |
| Enumeration Date | 2013-06-17 |
| Last Update Date | 2018-06-07 |