| NPI | 1275701153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX 8359) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CO 2590) |
| Enumeration Date | 2008-02-13 |
| Last Update Date | 2012-02-13 |