| NPI | 1295099570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: RI LP03737) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 264533) |
| Enumeration Date | 2012-07-01 |
| Last Update Date | 2019-06-24 |