| NPI | 1306801071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX K8565) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: KY K266750) |
| 207N00000X Dermatology (Licence: FL ME133767) | |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2024-03-22 |