| NPI | 1215237870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207NP0225X Dermatology Pediatric Dermatology (Licence: AZ 50872) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R71954) |
| 207N00000X Dermatology (Licence: OR PG168338) | |
| Enumeration Date | 2010-10-29 |
| Last Update Date | 2016-06-10 |