| NPI | 1275734022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MO 2008007454) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: ND 23067) |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2025-09-24 |