| NPI | 1326357799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: GA 70771) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS11610) |
| 207Q00000X Family Medicine (Licence: GA 70771) | |
| Enumeration Date | 2010-10-01 |
| Last Update Date | 2015-01-28 |