| NPI | 1265435580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NC 98-01669) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NV 16150) |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2016-12-15 |