| NPI | 1306936794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: ID M4775) |
| Additional Taxonomies | 174400000X Specialist (Licence: ID M-4775) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2018-12-05 |