| NPI | 1255395836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NM NM80241) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NM 80241) |
| Enumeration Date | 2006-04-12 |
| Last Update Date | 2009-09-02 |