| NPI | 1164733937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX P9332) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TX BP20040185) |
| Enumeration Date | 2010-06-28 |
| Last Update Date | 2026-03-10 |