| NPI | 1336139690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX N4132) |
| Additional Taxonomies | 202K00000X (Licence: TX N4132) |
| 207RI0200X Internal Medicine, Infectious Disease (Licence: DC MD32310) | |
| Enumeration Date | 2005-10-26 |
| Last Update Date | 2023-10-24 |