| NPI | 1134683873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: PR 23011) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 23011) |
| Enumeration Date | 2019-01-28 |
| Last Update Date | 2023-08-02 |