| NPI | 1316905631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NC 9501356) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: SC MMD16384MD) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2023-12-21 |