| NPI | 1437230695 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: VA 0101270755) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MD060818L) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2023-12-20 |