| NPI | 1194713016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: GA 034447) |
| Additional Taxonomies | 174400000X Specialist (Licence: GA 034447) |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2019-05-30 |