| NPI | 1215934062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX K5033) |
| Additional Taxonomies | 174400000X Specialist (Licence: AR E2607) |
| 174400000X Specialist (Licence: OK 20679) | |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2024-06-12 |