| NPI | 1184299893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: SC 86119) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 86119) |
| Enumeration Date | 2021-05-25 |
| Last Update Date | 2025-04-06 |