| NPI | 1326278011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: SC MD20721) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NC 13546) |
| Enumeration Date | 2009-07-16 |
| Last Update Date | 2009-07-16 |