| NPI | 1447494885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 61005) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: GA 61005) |
| Enumeration Date | 2009-04-29 |
| Last Update Date | 2009-04-29 |