| NPI | 1194942151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CO 2226) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 303395) |
| 207N00000X Dermatology (Licence: WI 54350) | |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2025-09-10 |