| NPI | 1215924634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MA 41366) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NH 6631) |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2010-03-15 |