| NPI | 1326149949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL OS9887) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL OS9887) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2015-01-20 |