| NPI | 1316365349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX S7317) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MD D0087643) |
| Enumeration Date | 2014-04-07 |
| Last Update Date | 2021-12-10 |