| NPI | 1427160548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AZ 15963) |
| Additional Taxonomies | 174400000X Specialist (Licence: AZ 15963) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2020-06-05 |