| NPI | 1154767457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: KY 49994) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: SC LL3077) |
| 207R00000X Internal Medicine (Licence: NC 192591) | |
| Enumeration Date | 2013-05-14 |
| Last Update Date | 2021-10-27 |