| NPI | 1457323131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: KY 60481) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: OK 18006) |
| Enumeration Date | 2006-02-06 |
| Last Update Date | 2025-04-23 |