| NPI | 1285668780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX G5850) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: KS 0421188) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2011-06-13 |