| NPI | 1164409819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: HI MD-12603) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: HI 12603) |
| Enumeration Date | 2005-12-23 |
| Last Update Date | 2015-02-24 |