| NPI | 1396722765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MO 2008021956) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NC 200700075) |
| 207N00000X Dermatology (Licence: WI 30823021) | |
| 207N00000X Dermatology (Licence: IA 01955) | |
| 207N00000X Dermatology (Licence: VA 0102201530) | |
| Enumeration Date | 2005-12-28 |
| Last Update Date | 2015-02-13 |