| NPI | 1174592349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OR 14062) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: OR MD14062) |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2024-08-02 |