| NPI | 1306103064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA 149110) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA 149110) |
| Enumeration Date | 2012-04-19 |
| Last Update Date | 2019-08-26 |